Technical Field
The present disclosure relates to the detection and assessment of fissures between lung lobes, and, more specifically, to systems, devices, and methods for using the detection and assessment of fissures between lung lobes in surgical and interventional planning. The disclosure further relates to the detection and assessment of an invasion by tumors or other aberrant structures in the pleural surfaces or other critical structures of the lungs, the pericardium, and/or the diaphragm, and, more specifically, to systems, devices, and methods for using the detection and assessment of an invasion of the pleura by aberrant structures in surgical and interventional planning.
Description of Related Art
Pulmonary disease may cause one or more portions of a patient's lungs may lose its ability to function normally and thus may need to be surgically resected. Surgical resection procedures may be very complex and would be greatly aided if the surgeon performing the procedure can visualize the way the diseased lung portions are shaped, and particularly how the fissures between the different portions of the lungs are developed or may have been deformed due to the disease.
Generally, a patient's lungs are divided into 5 lobes: an upper, middle, and lower lobe comprising the right lung, and an upper and lower lobe comprising the left lung. The lungs are surrounded by the pulmonary pleura. The pleura are composed of two serous membranes: the outer parietal pleura line the inner wall of the rib cage, and the inner visceral pleura directly line the surface of the lungs. The lung lobes are formed by recessions in the pleura, also known as fissures. The fissures are double folds of the pleura that section the lungs into the different lobes. Both the right and left lungs also have a central recession called the hilum at the root of the lung where airways, vascular, and lymphatic lumens pass into the lungs.
By viewing the patient's lungs prior to surgery, the clinicians and surgeons may visualize exactly how the patient's lungs are formed, the locations of the various lobes and fissures, where any potential incomplete fissures are located, the degree of incompleteness of any of the fissures, and potential vascular abnormalities that might be associated with this. However, it is very difficult to accurately visualize the fissures of the lungs by simply viewing computed tomography (CT) images of the patient's chest. As such, surgeons often start a surgery without prior knowledge of the degree of completeness of the fissures and the corresponding vascular anatomy. Complete fissures typically improve the ease with which a surgical resection can be performed, especially where the fissure constitutes one boundary of the resection—such as in a lobectomy. The fissures can also impute the potential for collateral airflow between segments and lobes with the attendant effects noted in patients with emphysema or other lung diseases. Further, when fissures are incomplete, identification of the vascular bundle subtending that area becomes more challenging and can also imply aberrancy with respect to vascular distributions. Thus, discovery of incomplete fissures at the time of surgical resection can be quite troublesome and render an otherwise uncomplicated surgery quite a bit more complicated as vascular structures need to be identified, etc., and therefore lengthening operative times. In procedures to treat other lung diseases, such as emphysema, advance knowledge of the degree of completeness of the fissures can also have a substantive impact on how those procedures are approached. Systems, devices, and methods for improving on the process of identifying and visualizing fissures of a patient's lungs are described below.